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The number of long-term care centers that have outbreaks of positive coronavirus cases has doubled, according to new data released by the Iowa Department of Public Health on Tuesday.

Six care centers have reported a total of 202 cases. Those six are considered to have an "outbreak," meaning there are three or more residents who test positive for COVID-19, the respiratory illness caused by the virus.

As of Tuesday, 1,899 Iowans have tested positive for disease and 49 have died. More than half of Iowans who have died of COVID-19 were residents of long-term care centers, Gov. Kim Reynolds said Monday.

The new outbreaks include 22 cases at On With Life, a rehabilitation center for people with brain injuries in Ankeny; six at Trinity Center at Luther Park Community, a nursing home specializing in Alzheimer's and dementia care in Des Moines; and six at Bartels Lutheran Retirement Community in Waverly.

The state's largest outbreak remains at Heritage Specialty Care in Cedar Rapids, where at least 102 residents and staff have tested positive. Seventeen residents had died as of Monday.

Other outbreaks include 47 cases at Premier Estates of Toledo in Tama and 19 cases at McCreedy Home in Washington.

"The Department of Public Health and the local public health officials are working with the management and staff at the facilities to ensure that all steps are being taken to make sure that we isolate sick residents, assign dedicated staff members to provide their care, and monitor all other residents," Reynolds said at a news conference Tuesday.

'The coming days will be tough…'

In a statement, Trinity Center's interim CEO Carol Sipfle said the east side facility has 10 positive COVID-19 cases — four more than what the state's numbers reflect due to delays in reporting. One case is an employee, who is not at work and is self-isolating at home, Sipfle said.

Employees who are coming to work are screened for symptoms each day, the facility has restricted visitors and staff has canceled all group activities.

Each of the residents with coronavirus are quarantined on a single wing of the nursing home, Sipfle said.

The Waverly retirement home has also moved its residents with coronavirus into isolation to help reduce the spread, according to a statement from CEO Paula Geise.

In a statement, Jean Shelton, CEO of On With Life, said the pandemic "is the most significant challenge On With Life has experienced," but is something for which her team has prepared.

On With Life has restricted visitors to its Ankeny facility since March 12 and has been accepting donations of personal protective equipment from the organization's supporters.

"Keep our persons served and their families in your thoughts as they continue their rehabilitation journey. Continue to follow recommendations related to social distancing to limit the spread of this highly contagious virus," Shelton's statement says. "The coming days will be tough, but our persons served and families will provide us with hope and purpose as we continue On With Life's mission."

Several more of the state's 440 long-term care facilities have reported coronavirus infections of residents and staff that do not reach the state's threshold for an outbreak.

For instance, Linn County reported Monday that two residents at Linn Manor in Marion have died and three employees have been sickened after testing positive for COVID-19.

A Linn County public health official, Heather Meador, said Monday the county considers that an outbreak. The state, however, does not.